Notalgia paresthetica (NP) causes itchiness and sometimes pain on the back. It tends to affect a specific area — usually under a shoulder blade and often on the left side.

NP results from a problem processing pain and itch signals. It affects the nerves.

There may be no visible symptoms, such as a rash. But for some people with NP, the affected area is dar0.5ker, or hyperpigmented, compared with the surrounding skin.

This article explores the causes and treatments of NP, as well as how doctors diagnose it.

Several different treatments may help, including:

  • Skin creams: For example, products containing capsaicin, a compound in chili peppers, often reduce pain from NP. A doctor may also recommend a cream or ointment that contains a steroid, such as hydrocortisone. A person can purchase these over the counter, but the doctor may prescribe a stronger version.
  • Medications: Various medications may help ease NP symptoms, and it can take time to identify the most effective drugs and dosages. Antiseizure medications, such as gabapentin (Neurontin), may be particularly effective.
  • Physical therapy: This can help release trapped nerves, which may ease the symptoms of NP.
  • Injections: For example, injections of botulinum toxin (Botox) may help relieve the pain and itchiness. An injected nerve block medication, which prevents certain sensations, can also help.
  • Surgery: When other treatments fail and a compressed or trapped nerve is responsible for the symptoms, surgery to decompress the spine and free trapped and damaged nerves may provide relief.
  • Less invasive medical procedures: Laser therapy may change the nerve sensations, and pulsed radio frequency and electrical muscle stimulation may ease the pain.
  • Alternative and complementary medicine: Some people may find relief from approaches such as acupuncture, especially if these accompany conventional treatments.

There may be a link between itchiness that stems from a nerve problem, such as NP, and problems in the spine. For this reason, regular exercises may help relieve NP symptoms.

A doctor or physical therapist may recommend exercises that strengthen the paraspinal muscles, the neck muscles, and the back overall. Squat exercises that target the back and waist can also help.

In a 2021 study, 12 people with NP did this type of exercise program after warming up three times a week. Each time, they did four sets of exercises and 10 repetitions of each set. Those who continued doing the exercises for the full 12 weeks of the study reported 50–100% improvement in their symptoms.

Resistance training may be particularly helpful in reducing the symptoms of NP. The following are two examples:

Suspended row

  1. Hold the two handles of a suspension band and stand facing the band’s anchor point.
  2. Keep the body straight and make a row movement with the upper body, opening up the elbows in a row motion.
  3. Start with keeping your elbows in a low row at about a 45 degree angle. If able, keep the elbows higher up to 90 degrees for a higher row.
  4. Keep the shoulders down and back, moving only the the upper body and making sure to feel a squeeze behind the shoulder blades during the movement.

Banded air squat

  1. Stand with the feet feet apart just past the hips.
  2. Wrap a resistance band over both thighs and make sure to feel resistence between the legs. s
  3. Squat down while pressing the glutes backwards
  4. Hold the squat for a few seconds before standing back up.

Dry skin, allergic reactions, and skin diseases can cause itchiness in specific areas. However, these are not the causes of NP.

Doctors do not fully understand NP, but most research indicates that it is a type of nerve pain, or sensory neuropathy. Some potential causes may include:

  • Spinal nerve compression: Degenerative diseases, such as arthritis, can damage the spinal column. When this happens, nerves can become trapped, and these nerves can generate pain and itchiness.
  • Chemically induced nerve damage: Medications and toxic chemicals can damage the nerves, causing itchiness and other unusual sensations.
  • Injuries: Nerve damage can result from an injury to the spine, the nerves around the spine, the muscles, and the bones in the area. This damage can cause the pain or itchiness.

There may be additional causes that researchers have yet to identify.

While reported cases of NP are fairly rare, doctors and researchers believe that it may be relatively common but underdiagnosed.

Symptoms of NP include:

  • itchiness of the back, usually in a specific area, such as under the left shoulder blade
  • itchiness that persists and does not seem to follow an injury or allergic reaction
  • increased sensitivity of the itchy area
  • hyperpigmentation of the affected area, possibly due to scratching and inflammation
  • pain in a specific area of the back, usually on just one side

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Notalgia paresthetica is a condition where intense itching occurs on one side of the back.
Maroliver, CC BY-SA 4.0, via Wikimedia Commons
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Notalgia paresthetica is a condition that involves severe itching, usually on one side of the back.
Akram A. Notalgia Paresthetica: Cervical Spine Disease and Neuropathic Pruritus. Cureus. 2021;13(1):e12975. Published 2021 Jan 28. doi:10.7759/cureus.12975
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Notalgia paresthetica is an underdiagnosed condition that causes itching, usually on one side of the back.
Ellis C. Notalgia paresthetica: the unreachable itch. Dermatol Pract Concept. 2013;3(1):3-6. Published 2013 Jan 31. doi:10.5826/dpc.0301a02

To diagnose NP, a doctor examines the itchy spot and takes a complete medical history. They may ask about recent injuries, muscle pain, infections, or chronic skin problems.

The doctor may also ask about any allergies or recent rashes because similar symptoms can follow an allergic reaction called dermatitis.

Doctors diagnose NP based on their observations and the person’s answers to these questions — there is no test for it. The affected area may be discolored in some people.

A doctor may also recommend a skin biopsy to rule out skin cancer. Biopsies sometimes show deposits of a type of protein called amyloid, and these deposits may form because of the itchiness and scratching.

Before confirming an NP diagnosis, the doctor may want to rule out macular amyloid, another condition that causes itchiness on the back. Macular amyloid usually causes itchiness on the upper part of the middle back, as well as grayish-brown discoloration of the skin.

Pain from herpes-related nerve damage may also cause itchiness, so a doctor might ask about any history of shingles.

NP is a chronic condition. It may go away on its own or with treatment, but it may last for many years.

Some people have to experiment with several treatments before finding the best option, and an approach that has worked in the past may stop working, requiring a change of treatment.

The symptoms can also change with time, getting better then worse or transitioning from itchiness to pain.

NP is not dangerous. It does not increase the risk of a serious illnesses, and it does not spread to other areas.

Unexplained itchiness can be concerning, and anyone who experiences this should contact a healthcare professional.

While NP can be bothersome and distracting, and it may reduce the quality of life, it is otherwise not dangerous. Treatment focuses on relieving the symptoms.